A company is looking for a Claims Examiner-Product.
Key Responsibilities
Review and analyze health care claims for cost reasonableness, medical necessity, and potential fraud
Determine benefit levels for claims and negotiate discounts with providers
Process claims in the QicLink System and document findings in relevant databases
Required Qualifications
High School Diploma; College and Advanced Degrees preferred or equivalent work experience
Minimum of 5 years of medical claims analysis experience, including dental and vision
Strong analytical skills and knowledge of CPT and ICD-9 coding terminology
Continuing education in areas affecting group health and welfare plans is required
Must comply with applicable privacy and security laws, including HIPAA and HITECH
Claims Examiner • Decatur, Georgia, United States
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